Different systolic blood pressure targets for people with history of stroke or transient ischaemic attack: PAST-BP (Prevention After Stroke--Blood Pressure) randomised controlled trial.
Different systolic blood pressure targets for people with history of stroke or transient ischaemic attack: PAST-BP (Prevention After Stroke--Blood Pressure) randomised controlled trial.
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DOI：
10.1136/bmj.i708
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发表时间：
2016-02-24
期刊：
影响因子：
--
通讯作者：
Hobbs FD
中科院分区：
文献类型：
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作者：
Mant J;McManus RJ;Roalfe A;Fletcher K;Taylor CJ;Martin U;Virdee S;Greenfield S;Hobbs FD
目的评估强化血压目标是否能降低社区脑血管病人群的血压。设计开放标签随机对照试验。在英格兰设置99个一般的做法，在2009-11年招募的参与者。研究对象：有脑卒中或短暂性脑缺血发作史，收缩压≥ 125 mm Hg者。强化收缩压目标（<130 mm Hg或从基线降低10 mm Hg，如果这是<140 mm Hg）或标准目标（<140 mm Hg）。除了目标不同外，两组患者的积极管理方式相同，并由初级保健团队进行定期审查。主要结果测量基线和12个月之间收缩压的变化。结果529例患者（平均年龄72岁）入组，266例入组强化靶组，263例入组标准靶组，其中379例纳入主要分析（182例（68%）入组强化组; 197例（75%）入组标准组）。84例患者在随访期间退出研究（强化组52例;标准组32例）。强化目标组的平均收缩压下降16.1 mm Hg至127.4 mm Hg，标准组下降12.8 mm Hg至129.4 mm Hg（组间差异2.9（95%置信区间0.2至5.7）mm Hg; P=0.03）。结论：在初级保健中，脑血管疾病患者的收缩压目标低于130 mm Hg而不是140 mm Hg，导致血压小幅额外降低。在这一人群中，使用<140 mm Hg的目标积极管理收缩压，可导致具有临床意义的血压降低。试验注册当前对照试验ISRCTN 29062286。
Objective To assess whether using intensive blood pressure targets leads to lower blood pressure in a community population of people with prevalent cerebrovascular disease. Design Open label randomised controlled trial. Setting 99 general practices in England, with participants recruited in 2009-11. Participants People with a history of stroke or transient ischaemic attack whose systolic blood pressure was 125 mm Hg or above. Interventions Intensive systolic blood pressure target (<130 mm Hg or 10 mm Hg reduction from baseline if this was <140 mm Hg) or standard target (<140 mm Hg). Apart from the different target, patients in both arms were actively managed in the same way with regular reviews by the primary care team. Main outcome measure Change in systolic blood pressure between baseline and 12 months. Results 529 patients (mean age 72) were enrolled, 266 to the intensive target arm and 263 to the standard target arm, of whom 379 were included in the primary analysis (182 (68%) intensive arm; 197 (75%) standard arm). 84 patients withdrew from the study during the follow-up period (52 intensive arm; 32 standard arm). Mean systolic blood pressure dropped by 16.1 mm Hg to 127.4 mm Hg in the intensive target arm and by 12.8 mm Hg to 129.4 mm Hg in the standard arm (difference between groups 2.9 (95% confidence interval 0.2 to 5.7) mm Hg; P=0.03). Conclusions Aiming for target below 130 mm Hg rather than 140 mm Hg for systolic blood pressure in people with cerebrovascular disease in primary care led to a small additional reduction in blood pressure. Active management of systolic blood pressure in this population using a <140 mm Hg target led to a clinically important reduction in blood pressure. Trial registration Current Controlled Trials ISRCTN29062286.